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Daily PrEP is suitable for all people who are at risk of HIV. Daily PrEP is the only PrEP regimen that is recommended for cisgender women, transgender women on exogenous oestrogen therapy, transgender men who have vaginal sex, and for people who inject drugs (PWID) (6).

The Therapeutic Goods Administration (TGA) has not approved this regimen in Australia but may be suitable for certain populations as an off label indication. On-demand PrEP would be suitable for those PrEP users

choice between daily and on-demand† PrEP. In this setting, daily PrEP would be preferential for those MSM who cannot predict when sex will occur, who cannot delay sex for more than 2 hours and for those whose potential exposure to HIV occurs more than twice a week. Daily PrEP is the only suitable regimen for cis-gender MSM with chronic hepatitis B infection to maintain virological suppression, prevent drug resistance and hepatitis flares. On-demand† PrEP would be suitable for those MSM whose preference is for the on-demand† regimen, who have sex less than twice a week, and who can plan ahead for sex at least 2 hours in advance.

Other reasons that MSM may choose or merit on-demand† PrEP include side-effects from daily PrEP, poor kidney function or financial constraints. The ASHM PrEP Guidelines Panel will continue to monitor HIV incidence in MSM using on-demand† PrEP, including those who use on-demand† PrEP less than fortnightly (11). whose preference is for the on-demand regimen, who have sex less than twice a week, and who can plan for sex at least 2 hours in advance. Other reasons that PrEP users may choose or merit on-demand PrEP include side-effects from daily PrEP, impaired kidney function or financial constraints.

Summary of when to recommend daily and on-demand^†PrEP

PrEP Based on the evidence, the ASHM PrEP Guidelines Panel continues to recommend daily TD*/FTC dosing for all populations suitable for PrEP.

The ASHM HIV PrEP Guidelines Panel recommends that on-demand† PrEP should be offered to cis-gender men regardless of the sex of their sexual partners. On-demand PrEP is also suitable for trans and gender diverse people assigned male at birth who are not taking oestradiol-based hormone therapy, as well as transgender men who do not have a uterus or do not engage in receptive vaginal sex.

For those suitable for on-demand PrEP, on-demand† PrEP should be offered when this preference is expressed, when the person has at-risk sex less than twice a week, when the at-risk sex is unpredictable, and when sex can be delayed for 2 hours.

^† The Therapeutic Goods Administration (TGA) has not approved this regimen in Australia.